There are many ways to help young people clarify the facts about HIV/AIDS and other STD and better understand the many related issues. This section presents some activities you can try. The activities are useful both to share new information and to observe what group members have already learnt.

Section 1 of this manual provides the factual information on HIV and AIDS and will help you to answer most questions asked by group members. In addition, for some activities, you will find a fact sheet with the essential information on a particular issue. These sheets can be copied and handed out to the participants.

Some questions may relate to medical information and, if necessary, additional information can be obtained from medical personnel. Sometimes there is no clear answer available to a particular question, and it is better to be honest and say: “I don’t know but I’ll try to find out” rather than guessing what is right or wrong. You can either refer the person to an organization or service which should have the required information or note down the question, obtain the correct information and get back to the person concerned later on. In this context we would like to stress that scientific terms and biological-technical details on HIV and other STD are less important than the basic and practical information on how to avoid infection.

You may also want to share information by using videos about HIV/AIDS. The resource list in Appendix VI includes some examples of good videos (but first read the guidelines on the use of videos in Appendix I: Techniques for educational activities). Preparing your own flip chart is another way to share information.

Fact or myth?

Objective

To provide information on physical and sexual development in adolescence

Time

90 minutes

Technique

Discussion

Materials needed

Enough copies of the quiz sheet

Enough copies of the fact sheet: Stages of the menstrual cycle Pens

Method

1. Explain to the participants that, together, you are going to discuss questions they may have concerning their sexual development. Stress the fact that this is not a test for their knowledge, but just a method to look at the many rumours about sexuality, which are sometimes true facts, but may sometimes be false myths.

2. If the literacy level of the group is high enough, you can copy and distribute the quiz sheet (see page 58), which is a list with six statements, and ask the participants to circle the correct answer.

3. An alternative is to read aloud the statements and have the participants vote on FACT or MYTH (if you use this alternative, however, keep in mind that some participants may be influenced by the opinions of their peers).

4. Have a discussion about each statement. Make sure everyone agrees with the correct answers. Give additional information if necessary. It may be useful to distribute the fact sheet: Stages of the menstrual cycle.

Answers and suggested comments for each statement:

1.A pregnancy before the age of 18 endangers a girl’s health:

FACT

Pre-teen and teenage girls are not fully developed. A young girl’s pelvis is narrow which can cause complications during delivery.

Being a teenage mother puts also a girl’s mental health at risk: adolescents are often not mentally mature enough to take all the responsibilities of parenthood; for most girls, motherhood also means leaving school and spoiling future opportunities for employment.

Teenage mothers also tend to have a higher-than-average rate of premature births and low birth-weight babies, which endangers the health of the baby.

2.Frequent masturbation is dangerous for your health:

MYTH

Masturbation is a normal sexual activity, practised by both sexes. Even frequent masturbation is normal and does not endanger someone’s health. It is also practised in adulthood.

3.It is unhealthy for a girl to bath or swim during her menstrual period:

MYTH

There is no reason why a woman should not indulge in specific activities during her period, unless she has cramps or any discomfort. However, she must be careful maintain good standards of personal hygiene.

4.When a girl has sex for the first time she cannot become pregnant:

MYTH

A girl can get pregnant with any single intercourse, including her first one!

5.A girl can become pregnant before she has had her first menstrual period:

FACT

Because a woman’s ovaries release an egg before the onset of her menstrual period, it is possible for a girl to get pregnant before her first menstrual period. (See fact sheet: Stages of the menstrual cycle.)

6.If a girl is still a virgin after the age of 20, she will be difficult to penetrate and it will be difficult for her to have children:

MYTH

The opposite is true: when a girl has first sexual intercourse at a very young age penetration can be very harmful.

Women are fertile, able to get pregnant, until the age of the menopause (about the age of 50), when the monthly menstruation stops.

Quiz sheet – one copy for each participant

Fact or myth?

FACT

MYTH

1 A pregnancy before the age of 18 endangers a girl’s health

2 Frequent masturbation is dangerous for your health

3 It is unhealthy for a girl to bath or swim during her menstrual period

4 When a girl has sex for the first time she cannot become pregnant

5 A girl can become pregnant before she has had her first menstrual period

6 If a girl is still a virgin after the age of 20, she will be difficult to penetrate and it will be difficult for her to have children

Stages of the menstrual cycle

Endometrium – day 5 (lining of the uterus)

Endometrium – day 14

Endometrium – day 19

Endometrium – day 1 (first day of menstrual period)

The immunity play

Objective

To provide information on how the immune system works in a healthy person and how HIV damages it

Time

60 minutes

Technique

Storytelling

Materials needed

The text for the storyteller

The group can have more fun and the play made more interesting by getting the group to make costumes for each actor or simply by making labels with the name(written or drawn) of each character which is stuck or pinned onto the appropriate person.

Method

1. Tell the participants that you are going to perform a play on how HIV can attack our immune system. Ask for volunteers to act the following roles:

Mary Mary’s immune system (a group of people) HIV an infected boil a storyteller

2. Give the script to the storyteller, who stands at the side of the room and reads the story aloud.

Give instructions to the other actors in the play (the stage directions are in brackets).

Here is the script of the play:

Storyteller:

This is the story of how a healthy immune system works and how HIV damages the system.

(Mary comes forward and stands in the middle of the room.)

Storyteller:

Mary is protected from infections by her immune system.

(Small group of people, holding hands in a circle, surrounds Mary.)

Storyteller:

When she gets an infection, her immune system fights it and Mary becomes well again.

(An infected boil comes forward, Mary looks in pain. The boil tries to break through the immune system circle, but they do not let him and he goes away.)

Storyteller:

Mary has had sex with her boyfriend. He did not use a condom and she felt too shy to ask him if he would. Now Mary has become infected with HIV because her boyfriend carries the virus and they have had unprotected sex.

(HIV comes forward and starts to fight with Mary’s immune system. HIV manages to get inside the immune system circle. HIV hits one of the ‘immune-system’ actors who falls down.)

Storyteller:

Because HIV has managed to get inside Mary’s immune system and kill a part of it, her system is weak and cannot fight HIV. Because the immune system is damaged, it cannot fight off other infections.

(The rest of the immune-system actors fall on the floor.)

Storyteller:

Mary starts to get sick She now develops AIDS. She is very weak and finally dies.

The end

3. The play can be followed by a discussion. Use the question-and-answer information on AIDS in Section 1.

The group may want to use this play in schools or community events to show others how the virus works. Before putting on the play for an outside audience, spend some time discussing how to answer questions from the audience. (See also Section 6: Action with the community.)

The HIV/AIDS quiz

Objectives

To provide accurate information on AIDS and HIV

To deal with disbeliefs and sensitive questions about AIDS and HIV To check people’s knowledge about AIDS and HIV

You will find the basic information on this issue in Section 1.

Time

90 minutes

Technique

Quiz

Materials needed

1 quiz sheet per participant (see next page)1 pen per participant

Method

1. Clarify with your group that this quiz is not an exam, but simply a trigger for discussing information. Make sure everybody is relaxed.

2. Hand out the quiz sheets to the participants. Allow 10 to 15 minutes to complete the test by indicating TRUE or FALSE or I DON’T KNOW for each statement.

3.Option 1: Each participant fills in the test individually.

Option 2: Divide into pairs or small groups; these groups share their answers and come to a group decision about each question and answer.

4. Review the answers with the whole group. For each question, ask for a volunteer to answer. Ask the other participants if they agree. Make sure everyone agrees which answers are the correct ones. Discuss and give additional information if necessary. Go over the points on which there was no agreement.

5. Ask participants how they liked this activity.

Correct answers to the HIV/AIDS quiz

1 False

8 True

15 True

2 True

9 False

16 True

3 True

10 False

17 True

4 False

11 True

18 False

5 True

12 False

19 True

6 False

13 True

20 True

7 False

14 False

Quiz sheet – one copy for each participant

The HIV/AIDS quiz

True

False

I don’t know

1 Only homosexual men, injecting drug users and prostitutes can be infected with HIV.

2 An HIV-infected pregnant woman can pass the virus to her unborn baby.

3 The AIDS virus attacks the body’s defence system and makes a person vulnerable to other infections.

4 If you are fit and healthy you won’t become infected with HIV.

5 Anal sex is the riskiest sexual practice for becoming infected with HIV.

6 If you have only oral sex, you won’t become infected with HIV.

7 If you are seronegative it means that you are immune to HIV.

8 A baby can become infected with HIV through breastfeeding.

9 You can get AIDS from toilet seats.

10 You cannot become infected when you have unprotected intercourse one time only with an HIV-infected person.

11 When you have an STD and practise unprotected sex, you are at greater risk of HIV infection.

12 Married people don’t become infected with HIV.

13 You can be infected with HIV and not be aware of it.

14 You can be infected with HIV from sharing drinking glasses.

15 Only a blood test can tell if you are infected.

16 HIV is not spread through coughing or sneezing.

17 Condom use reduces the risk of HIV infection.

18 Women who use the birth-control pill cannot become infected with HIV.

19 You cannot get HIV infection from giving blood with sterile syringes.

20 Outside the body, the HIV virus cannot survive.

AIDS “memory game”

Objective

To provide a relaxed way for the group to increase their awareness of a specific aspect of HIV/AIDS information

This game/technique can be used to share information on many different themes related to HIV/AIDS. This sample uses the theme ‘HIV isn’t spread by...’. You can easily adapt the game to themes you consider more relevant to the needs of your group. For additional tips on how to select pictures for this type of activity, see Pictures and photographs, under Techniques for educational activities (Appendix I).

Time

45 – 60 minutes

Technique

Pictures and photographs

Materials needed

Two sets of pictures (see preparation)

Preparation

You need to prepare two sets of pictures on small cards related to the theme you have chosen. Try to find pictures from magazines or newspapers. Cut and paste the pictures onto small cards. Of course you can draw pictures on the cards yourself. For example, for the theme ‘HIV isn’t spread by...’, you might find pictures of people hugging, shaking hands, swimming, eating or being bitten by mosquitoes. You need to find or draw two pictures for each activity. Examples of drawings are shown on the right.

Figure

Method

1. Place the cards you have prepared face down on the table. For a group of 12 people you will need at least 15 sets of pictures. Remember each set has two cards with the same picture, or as closely alike as possible. Place the cards in equal rows.

2. Explain to the participants that the purpose of the game is to match as many cards as they can.

3. One after the other, each participant turns two cards face up. If the cards are the same or have the same message, the person takes the cards from their place and keeps them. If they are different, the person turns the cards back over in their original places.

4. As the participants take turns, they try to remember where the matching cards are placed.

5. When all the cards are picked up, the participants count their pile to see who has the most pairs of cards.

6. Now you can ask each player to describe the pictures they have collected and how their pictures relate to the theme. For example, if the theme is ‘HIV isn’t spread by...’, the group can discuss each picture and decide if the actions or situations in the picture could result in getting infected with HIV. If your group is literate, you or a participant could make a list on a flip chart, big piece of paper or blackboard of ways to avoid getting infected with HIV. This discussion also gives the group leader a chance to answer questions and clarify information.

Risky or not?

Objective

To provide accurate information on how HIV is transmitted

You will find the basic information on this issue in Section 1.

Time

90 minutes

Technique

Discussion

Materials needed

A set of statement cards (see below)

Four cards on which is written: HIGH RISK, LOW RISK, NO RISK, RISK DEPENDS ON...

Preparation

Before you start, you will need to prepare a set of statement cards. You will need at least one card for each person. Ideas for the statements should come from your findings in the focus-group discussions, so that this activity helps give your group exactly the information they need and clarifies their concerns. Photographs or illustrations drawn by participants can be used instead of written statements.

Suggestions for statement cards

Kissing on cheeks

Sleeping in the same room as

n Having an injection at a local

someone living with AIDS

pharmacist’s or clinic

Being tattooed

Oral sex

Anal sex

Having sex within marriage

Hugging someone who is infected

Having a blood transfusion

with HIV

Using someone else’s toothbrush

Being bitten by bedbugs

Swimming in a pond

Using a public latrine

Caring for someone living with AIDS

Having sex with a drug user

Being bitten by a mosquito

Witchcraft

Having many sexual partners

Group circumcision

Having your ears pierced

Tongue kissing

The suggestions for the statement cards may or may not be suitable for your culture or your group. It is important that the statements be relevant to the group’s information needs and the youth members’ lives. Select those statements that are appropriate for your group or create your own cards.

Method

1. Ask the group to imagine or draw a ‘line of risk’ on the floor. Label one end of the line with the HIGH RISK card and the other end with the NO RISK card. Place the LOW RISK card somewhere in the middle. Decide with the group a place for the RISK DEPENDS ON... card.

2. Have the group sit in a circle and give out the statement cards to each person. Explain that in all cases which involve person-to-person contact, one person may be HIV-infected.

3. Invite everyone to take turns in reading out what is on their card and to place it where they think it belongs on the line of risk that you have drawn. Ask them to tell the group why they have put it there. Remind them that they can place the cards in the RISK DEPENDS ON... space.

Anyone can challenge them with more information and suggestions about where the card ought to go. The person placing the card can change his/her mind and move the card or leave it where it is. Then, the next person takes a turn, and so on until all the cards are laid out.

4. Identify cards about which there is no disagreement. Put these on one side. Then discuss the cards about which there are questions or disagreements. Try to reach a consensus in the group. Provide the necessary factual information to help the group make decisions about each risk activity.

5. Go around the circle and ask the participants what is the most important thing he/she has learned. Review the most important points.

It may be helpful at the end of the exercise to list the activities under each risk category. Discuss with the group if there are any issues or questions they would like to explore further. This may help you decide what other activities the group needs.

Suggested answers

HIGH RISK

Anal sex. Anal sex is a very risky activity for transmitting HIV since the lining of the anus tears and can bleed, providing a way for semen to get into the blood quickly. The only way to reduce this risk is by using condoms and if possible special, thicker condoms. (See Appendix III: Condoms and safer sex.)

Having many sexual partners. Having sex with many partners increases the risk of becoming infected with HIV. However, it is not just a question of how many partners you have. Any one act of unprotected intercourse (sex without a condom) with a person who is infected with HIV could result in your becoming infected. (This is a good opportunity to go over the information on safer sex.)

Having sex with a drug user. If a person uses drugs by injection and does not use a clean needle or syringe every time but borrows other people’s, then he/she is at high risk of getting infected with HIV. Having sex with someone who behaves in this way is also very risky. Using drugs or alcohol in any form affects your judgement, so you are more likely to engage in unsafe sex and put yourself at risk of infection when under their influence.

Group circumcision. Many societies circumcise young people in groups. When instruments are not sterilized between each use, they could pass on HIV.

LOW RISK

Having your ears pierced. If sterile procedures and disposable needles are used there is no risk. However, if everyone in a group is having his/her ears pierced and is using the same needle, then group members are subject to a certain risk. Being tattooed is a practice that also requires that sterile instruments be used every time.

Using someone else’s toothbrush. A practice that should be avoided because of general risk of minor infections being passed from mouth to mouth. No known cases of AIDS have been passed in this way but it is possible to catch hepatitis-B which is also a very serious disease.

Tongue kissing. Tongue kissing, or kissing each other with open mouths, could carry a risk only if there were an exchange of blood from an HIV-positive person to his/her partner. Bleeding might occur because of damage caused to the skin or mucous membrane around the mouth. Saliva does not contain HIV in sufficient quantities to be infectious.

NO RISK

Using a public latrine. The virus is not passed on by urine or faeces. HIV has been found in these body fluids but not in a sufficient concentration to spread the virus.

Swimming in a pond. HIV is very fragile outside the body. Water dilutes the virus so it wouldn’t be concentrated enough to infect you even if it could find a way into the body.

Kissing on cheeks. Again there is no way for the virus to get into your body.

Caring for someone living with AIDS. There is no risk if you follow good hygiene practices. Make sure any cuts on your hands are covered; wrap up and burn any dressings soaked with blood; wash soiled linen with hot water and soap and dry them in the sun. The person you are caring for deserves all the care and attention that anyone might expect to receive.

Being bitten by a mosquito (that has bitten someone who is infected with HIV).

If HIV were transmitted by mosquitoes or head lice, we’d expect to see infection in children which could not be explained in any other way. Infection in children is only seen when they have been infected in their mother’s womb, through breast milk, through blood products or sex. HIV cannot be spread through insect bites.

Sleeping in the same room as someone living with AIDS. No risk, unless the person is suffering from open TB, in which case there would be a risk of being infected with TB and not with HIV. People living with AIDS can often feel isolated and lonely, so it may be important for them to feel someone is happy to share a room with them.

Hugging someone who is infected with HIV. No risk. It is important to show that you care. There is no route of infection for the virus in hugging.

Witchcraft. AIDS is caused by a virus, not by ill-wishing or other such activities.

RISK DEPENDS ON...

Having sex within marriage. This behaviour is only without risk if both partners are uninfected and if there is mutual fidelity between them. In some societies where polygamy is practised, it is important that all partners within the marriage remain mutually faithful.

Having a blood transfusion. In most industrialized countries the risk of acquiring HIV infection from a blood transfusion is extremely low. However, in the developing world, donated blood is not always screened for HIV and the blood you receive by transfusion may contain HIV. So the activity could carry a high risk. (You should decide on where this card goes depending on your local situation.)

Oral sex. This is a difficult area as we are not sure yet if oral sex carries any great risk, especially if the man doesn’t ejaculate in his partner’s mouth. Oral sex should never be practised if either partner has bleeding gums or mouth ulcers, because other infections like herpes could be passed on.

Having an injection at a local clinic or pharmacist’s. This carries no risk if the injection is carried out with a sterile needle every time. Small amounts of blood tend to remain in used needles and if the blood contains HIV, you could be infected this way.

The STD quiz

Objectives

To provide accurate information on STDTo deal with disbeliefs and sensitive questions about STDTo check people’s knowledge about STD

NO, most are curable, but there are exceptions such as herpes and HIV/AIDS.

6 Do you know straightaway that you have an STD?

NOT ALWAYS! You may have an STD but may have no symptoms for a long time (e.g., chlamydia for both sexes, gonorrhoea for women).

7 Give three possible symptoms of an STD.

Burning sensation when urinating. A drip from the penis. Discharge. Blister, ulcer or swelling on/around the genitals. Warts around penis, vagina, anus.

8 Why are some STD dangerous?

If not detected and treated, the infection can spread and can, for example, cause sterility in women. Syphilis can lead to death. The presence of an STD also facilitates HIV transmission.

9 Is AIDS an STD?

YES, when the virus is transmitted by sexual intercourse.

10 Name the two most effective ways to protect yourself from an STD infection.

Abstinence. Correct condom use.

11 What is the first thing to do when your doctor tells you that you have an STD?

Inform your partner(s) and encourage him/her to go and see a doctor as well.

12 Your doctor prescribed you medicine to be taken for 10 days. After five days the symptoms have disappeared. Can you stop taking medicine?

NO. Some STD germs are hard to kill and the medicine must, therefore, be taken until the disease is completely cured.

13 Why are people who have an STD more vulnerable to HIV infection(the virus that causes AIDS)?

Many STD cause sores (openings on the skin in around the genitals). These sores make it easier for HIV to enter the body.

14 Can pregnant women who have an STD pass this infection to her baby?

YES, children born to infected mothers can become infected with an STD during delivery. The HIV virus can also be passed on to a baby through breastfeeding.

15 TRUE or FALSE? When you have an STD and you take medicine, you can have sex with your partner.

FALSE! You can infect your partner during treatment as well. Therefore, it is important not to have sex before you are completely cured.

16 TRUE or FALSE? The birth-control pill also protects a woman from being infected with STD.

FALSE! Birth-control pills do not prevent STD. The use of condoms is the only method that can prevent pregnancy and STD.

Method B

For this alternative method, follow the same instructions as for the HIV/AIDS quiz (see page 62). You need to copy the quiz sheet for the participants.

Correct answers to the STD quiz

1 True

8 False

2 False

9 True

3 True

10 True

4 False

11 True

5 True

12 True

6 False

13 False

7 True

14 False

Quiz sheet – one copy for each participant

STD quiz

(Method B)

True

False

I don’t know

1 You can be infected with an STD without realizing it.

2 You can buy medicine from the pharmacist (chemist) to treat STD without going to the doctor.

3 If a woman has an STD which is not treated correctly, she may have difficulties having children later on.

4 If you are very careful to follow strict personal hygiene, you cannot be infected with an STD.

5 STD are a great danger to young people.

6 As soon as the symptoms of an STD have disappeared, you can stop taking the medicine.

7 A condom protects you against STD infection.

8 Herpes is one of the STD that can be cured.

9 You can get vaccinated against hepatitis-B.

10 If you have an STD and you are taking medicine prescribed by your doctor, your partner should be treated as well.

11 A person who has an STD is more liable to get infected with HIV.

12 A woman may have gonorrhoea ('drip') and have no symptoms.

13 Women who take the birth-control pill are not at risk from being infected with STD.

14 Men who have an STD infection can be cured by having sex with a virgin.

Fact sheet

Sexually transmitted diseases (STD)

Sexually transmitted diseases are infections passed on by intimate body contact and by sexual intercourse. They are caused by different tiny organisms/germs (bacteria, viruses and protozoa).

People (especially women) may sometimes have an STD but have no symptoms for a long time! Therefore, it is always important to inform your partner that you have an STD and to encourage him/her to see a doctor.

Most STD can be cured if treated correctly. Some STD germs are hard to kill and the medicine prescribed by a doctor must, therefore, be taken until the disease is completely cured. A follow-up visit to the doctor or clinic is important.

It is important not to have sex before the treatment of an STD is completed.

Most STD do not cause serious problems if they are detected and treated early. If this is not the case, the infection may spread and cause serious complications such as sterility.

Most STD in pregnant women can infect their babies in the womb or during delivery and can cause serious illnesses.

Some STD, such as herpes or AIDS, cannot be cured. It is possible to treat the symptoms, but not cure the disease.

The best way of protecting yourself against STD is to use a condom when having sex.

Signs of STD

Women

Unusual discharge or smell from the vagina

Pain in the area between the lower abdomen (also called the belly or tummy) and sex organs

Burning or itching around the vagina

Bleeding from the vagina which is not a menstrual period n Pain deep inside the vagina when having sex

Men

A drip or discharge from the penis

Both men and women

Sores, bumps or blisters near sex organs or mouth Burning and pain when urinating or defecating Fevers, chills and aches – like the flu Swelling in the area around the sex organs

STD and young people

Increasingly, STD are a serious problem among young people. In many countries, STD infections mostly affect people aged between 15 and 29. In the USA, for example, every year 3 million adolescents contract a sexually transmitted disease, a clear indicator of unsafe sex. In developing countries, STD infection rates are often even higher.

However, services for prevention and care for STD are frequently neither accessible to nor appropriate for young people. It is essential, therefore, that young people are recognized as an important target group for STD prevention and care programmes.

The relationship between STD and HIV/AIDS

The presence of another STD can facilitate the transmission of HIV. Many STD cause sores, which are openings on the skin in and around the genitals. These sores make it easier for the AIDS virus to get into the body. (See also Section 1: Information about HIV/AIDS, How does a person become infected with HIV?) Thus, early diagnosis and effective treatment of STD are an important strategy for preventing HIV transmission.

The predominant mode of transmission of HIV and other STD is sexual. Therefore, ma